For older children—around ten and above—this can often be accomplished simply by talking with them and carefully asking them questions which encourage them to reveal themselves. With children younger than this, techniques involving play are often more effective. These allow children to relax more and “have fun” while expressing feelings and themes about their lives which may cause them concern or trouble them. After two or three of these sessions, I meet with parents in the feedback session, offer my opinions, and discuss recommendations for further intervention.

With older adolescents, the process is fairly similar, except that I find they often prefer to meet with the therapist before parents ever do, so they can decide on their own if they feel comfortable or not with me before going forward with the entire evaluation. Likewise, I often offer feedback directly to the older adolescent before giving it to parents, so they have the opportunity to hear it first and give their own responses to me in private. Afterwards, I meet with parents alone for a similar discussion, followed by a meeting with the adolescent and parents together for any further discussion. In all cases this initial feedback meeting may be followed by additional joint meetings and discussion to make sure everyone is in agreement with any treatment or further evaluation plan decided upon.

My aim in psychotherapy is always to help people understand the hidden reasons why they think, feel, and do the self-defeating things they do, so that they can make better choices in their lives. This can only occur in a professional atmosphere that is safe, ethical, and absolutely confidential.

Parent Counseling—Whenever a child or adolescent is treated, their most important sources of influence—parents—should be included in some fashion as well. Even if a kid were seen in psychotherapy seven days a week, their parents still have a far more powerful influence over their lives than a therapist could ever hope to have. Likewise, even the most skillful psychotherapy could be sabotaged or undone if parents are not fully supportive of and cooperative with the therapy, or if they are not supervising the child in a way that collaborates well with the aims of the therapy. Said more plainly, therapy for a child works best when everyone—therapist, parents, and child—are all on the same page and working closely together.

So parents need to meet with the therapist in some fashion, and there are several different methods, each with its advantages and disadvantages. In my opinion, the best way to involve parents in a child’s treatment is usually by having them meet with another mental health professional, one different than the child’s individual psychotherapist. This arrangement strongly supports the existence of confidentiality in the child’s individual psychotherapy, and gives the child the clear message, “Your therapist is your confidante, your special person who is on your side and does not have an agenda to be a parent towards you, nor a direct agent of your parents.” An advantage here for parents is that the time spent in these separate sessions is completely theirs, and they can focus on their difficulties maximizing the effectiveness of their strategies used to supervise the child patient. The time can also be used to examine the ways parents have conflicts working together and supporting each other in presenting the “united front” that is spoken about in so many written works on parenting.

An alternative to this strategy, less preferable in my view, is for parents to meet regularly with the child’s therapist. Here, parents can provide valuable information about the child’s current functioning, and about any progress or problems which might be occurring. The child’s therapist must then wear “two hats,” and function as direct advisor to parents as well as remaining confidante and wise consultant to the child; meanwhile, the child/adolescent patient can have worries about the therapist telling parents the private things they have discussed in therapy sessions.